Nusinersen, Risdiplam和Onasemnogene abparvovec治疗脊髓性肌萎缩的安全性问题:一项真实世界药物警戒研究。

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY Clinical Drug Investigation Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI:10.1007/s40261-023-01320-4
Wei Zhuang, Mei Lu, Ye Wu, Zhehui Chen, Minying Wang, Xudong Wang, Shaoxing Guan, Wanlong Lin
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引用次数: 0

摘要

背景和目的:脊髓性肌萎缩症(SMA)是一种治疗选择有限的遗传性疾病。为了给SMA患者做出明智的临床药物选择,全面了解药物安全性是至关重要的。由于纳入临床试验的患者数量有限,评估SMA治疗药物的安全性一直具有挑战性。本研究旨在调查和比较三种主要SMA治疗药物:nusinersen、risdiplam和onasemnogene abparvovec的潜在安全性问题。方法:采用FDA不良事件报告系统数据库对药物安全性进行分析,采用病例(SMA药物)/非病例(数据库中所有其他药物)方法,通过歧化分析和报告优势比(ROR)估计安全性信号。进行了even分析来比较和选择与每种药物相关的特殊不良事件(ae)。结果:纳入nusinsen 5324例,risdiplam 1184例,onasemnogene abparvovec 1277例。Venn分析揭示了三种药物中27种常见ae,包括心脏、胃肠、代谢、肌肉骨骼、肾脏、呼吸系统疾病和感染。此外,在nusinersen中发现的196例ae包括腰椎穿刺后综合征[ROR (95% CI) = 6120.91 (5057.01-7408.64), n = 372],手术疼痛[ROR (95% CI) = 54.86 (48.13-62.54), n = 234],特发性颅内高压[ROR (95% CI) = 6.12 (2.29-16.33), n = 4]和低钾血症[ROR (95% CI) = 2.02 (1.24-3.31), n = 16]。此外,短暂性耳聋被认为是一种意想不到的、罕见但严重的耳聋[ROR (95% CI) = 23.32 (8.71-62.44), n = 4]。与其他两种药物相比,Risdiplam仅显示50个ae,显著的特异性ae包括腹泻[ROR (95% CI) = 4.55 (3.79-5.46), n = 121]、疲劳[ROR (95% CI) = 2.03 (1.6-2.57), n = 70]、光敏反应[ROR (95% CI) = 9.50 (4.25-21.13), n = 6]、皮疹[ROR (95% CI) = 1.90 (1.36-2.67), n = 34]和[ROR (95% CI) = 4.3 (1.93-9.58), n = 6]。此外,肠梗阻[ROR (95% CI) = 11.11 (4.14-29.51), n = 4]、胃肠道出血[ROR (95% CI) = 2.55 (1.15-5.69), n = 6]和低血糖性无意识[ROR (95% CI) = 153.58 (62.98-374.54), n = 5]是与瑞司哌仑相关的罕见但严重的ae。Onasemnogene abeparvovec共鉴定出143例ae,其中肌钙蛋白I升高[ROR (95% CI) = 627.1 (492.2 ~ 798.99), n = 78]、肌钙蛋白T升高[ROR (95% CI) = 233.98 (153.29 ~ 357.15), n = 23]、血乳酸脱氢酶升高[ROR (95% CI) = 39.81 (28.88 ~ 54.87), n = 38]、转氨酶升高[ROR (95% CI) = 36.88 (29.24 ~ 46.52), n = 73]具有显著高信号。结论:本研究强调了监测nusinsen治疗患者注射相关损伤和短暂性耳聋事件的重要性。对于onasemnogene abparvovec,仔细监测肾功能损害、肝损伤和心肌损伤是必要的。利斯地普兰需要注意罕见但严重的胃肠道损伤事件和低血糖的潜在风险。重要的是,利地普兰表现出较低的肝脏和肾脏毒性,使其成为肝脏或肾功能不全患者或与其他具有高肝脏或肾脏毒性的药物联合使用的潜在考虑因素。这些发现可为药物选择和进一步的前瞻性研究提供参考。
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Safety Concerns with Nusinersen, Risdiplam, and Onasemnogene Abeparvovec in Spinal Muscular Atrophy: A Real-World Pharmacovigilance Study.

Background and objective: Spinal muscular atrophy (SMA) is a genetic disorder with limited treatment options. It is crucial to have a comprehensive understanding of drug safety in order to make informed clinical drug selections for patients with SMA. Assessing the safety profiles of therapeutic drugs for SMA has been challenging due to the limited number of patients included in clinical trials. This study aims to investigate and compare the potential safety concerns associated with three leading SMA therapeutic drugs: nusinersen, risdiplam, and onasemnogene abeparvovec.

Methods: The FDA Adverse Event Reporting System database was used to analyze drug safety, and a case (SMA drug)/noncase (all other drugs in the database) approach was employed to estimate safety signals through disproportionality analysis and reporting odds ratio (ROR). Veen analysis was conducted to compare and select the idiosyncratic adverse events (AEs) associated with each drug.

Results: The study included 5324 cases of nusinersen, 1184 cases of risdiplam, and 1277 cases of onasemnogene abeparvovec. Venn analysis revealed 27 common AEs among the three drugs, including cardiac, gastrointestinal, metabolism, musculoskeletal, renal, respiratory disorders, and infections. Additionally, 196 AEs exclusively found in nusinersen included post lumbar puncture syndrome [ROR (95% CI) = 6120.91 (5057.01-7408.64), n = 372], procedural pain [ROR (95% CI) = 54.86 (48.13-62.54), n = 234], idiopathic intracranial hypertension [ROR (95% CI) = 6.12 (2.29-16.33), n = 4], and hypokalemia [ROR (95% CI) = 2.02 (1.24-3.31), n = 16]. Additionally, transient deafness was identified as an unexpected and rare, yet severe, AE for nusinersen [ROR (95% CI) = 23.32 (8.71-62.44), n = 4]. Risdiplam exhibited 50 AEs exclusively, with notable idiosyncratic AEs including diarrhea [ROR (95% CI) = 4.55 (3.79-5.46), n = 121], fatigue [ROR (95% CI) = 2.03 (1.6-2.57), n = 70], photosensitivity reaction [ROR (95% CI) = 9.50 (4.25-21.13), n = 6], rash [ROR (95% CI) = 1.90 (1.36-2.67), n = 34], and [ROR (95% CI) = 4.3 (1.93-9.58), n = 6] in comparison with the other two drugs. Moreover, ileus [ROR (95% CI) = 11.11 (4.14-29.51), n = 4], gastrointestinal hemorrhage [ROR (95% CI) = 2.55 (1.15-5.69), n = 6], and hypoglycemic unconsciousness [ROR (95% CI) = 153.58 (62.98-374.54), n = 5] were rare but severe AEs associated with risdiplam. Onasemnogene abeparvovec had 143 exclusively identified AEs, with significant high signals for troponin I increase [ROR (95% CI) = 627.1 (492.2-798.99), n = 78], troponin T increase [ROR (95% CI) = 233.98 (153.29-357.15), n = 23], blood lactate dehydrogenase increase [ROR (95% CI) = 39.81 (28.88-54.87), n = 38], and transaminases increase [ROR (95% CI) = 36.88 (29.24-46.52), n = 73].

Conclusions: This study highlights the importance of monitoring injection-related injuries and transient deafness events in patients treated with nusinersen. For onasemnogene abeparvovec, careful monitoring for renal impairment, liver injury, and myocardial damage is necessary. Risdiplam requires attention to the potential risk of rare but severe gastrointestinal damage events and hypoglycemia. Importantly, risdiplam exhibited lower liver and renal toxicity, making it a potential consideration for patients with liver or renal insufficiency or for combined use with other drugs that possess high liver or renal toxicity. These findings can be a reference for drug selection and further prospective studies.

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来源期刊
CiteScore
5.90
自引率
3.10%
发文量
108
审稿时长
6-12 weeks
期刊介绍: Clinical Drug Investigation provides rapid publication of original research covering all phases of clinical drug development and therapeutic use of drugs. The Journal includes: -Clinical trials, outcomes research, clinical pharmacoeconomic studies and pharmacoepidemiology studies with a strong link to optimum prescribing practice for a drug or group of drugs. -Clinical pharmacodynamic and clinical pharmacokinetic studies with a strong link to clinical practice. -Pharmacodynamic and pharmacokinetic studies in healthy volunteers in which significant implications for clinical prescribing are discussed. -Studies focusing on the application of drug delivery technology in healthcare. -Short communications and case study reports that meet the above criteria will also be considered. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Clinical Drug Investigation may be accompanied by plain language summaries to assist readers who have some knowledge, but non in-depth expertise in, the area to understand important medical advances.
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